Anatomy Exam 4-Lower Limb

Front 1

In general describe the innervation of the lower extremity.

Back 1

femoral and obturator come from L2-4, sciatic is from L4-S3
1. anterior (flexor) division nerves-tibial (thigh, leg, foot) and obturator (medial thigh)
2. posterior (extensor (AKA dorsiflexion)) division nerves-femoral (anterior thigh), gluteals (hip) and peroneal (anterior thigh, leg, foot)

Front 2

Describe the development of the lower limb.

Back 2

the lower limb undergoes 180 degrees of medial rotation and becomes adducted so that the original posterior compartment becomes the adult anterior compartment, posterior compartment is actually facing forward in utero, orients the great toe on the medial side, is not completely finished at birth (is finished at ~8-11 months)

Front 3

What are some applications of the innervation patterns in the extremities?

Back 3

-terminal nerves from a plexus innervate muscles by groups of compartments, muscles in a compartment or group share similar functions
1. anterior thigh-femoral
2. anterior leg-peroneal
3. posterior thigh-tibial
4. posterior leg-tibial

Front 4

Describe the relation of spinal cord segments to movement in the extremities.

Back 4

-hip flexion (L2-3)
-knee extension (L3-4)
-ankle dorsiflexion (extension, L4-5)
-hip extension (L4-5)
-knee flexion (L5-S1)
-ankle plantarflexion (S1-2)
-plantar foot muscles (S2-3)

Front 5

What are the dermatomes of the lower limb?

Back 5

little toe is S1, big toe is L4/5

Front 6

What are the dermatomes of the lower limb?

Back 6

little toe is S1, big toe is L4/5

Front 7

What is the purpose of the lower limb?

Back 7

it is specialized for locomotion and to support body weight

Front 8

What do the muscles and joints structures need to allow for locomotion and support?

Back 8

1. muscles need a good blood supply and must be large
2. joints must sacrifice mobility for strength (so if had to walk on upper limb, should joint would undergo a lot of wear and tear), hip joints is extremely strong, can rest on capsule of hip joint, lots of articular contact, sacrifice mobility for extra strength

Front 9

What are the four segments of the lower limb?

Back 9

1. pelvic girdle = hip bones (composed of ilium, ischium and pubis) + sacrum, forms continuous ring that is the pelvic girdle
2. thigh-hip joint to knee
3. leg-composed of tibia and fibula
4. foot

Front 10

Describe the gluteal region.

Back 10

transitional region between trunk and free lower limb, bounded superiorly by the iliac crest, medially by the intergluteal cleft and inferiorly by the skin fold underlying the buttocks (gluteal fold)

Front 11

Describe the thigh region.

Back 11

contains femur which connects hip and knee, boundary between the thigh and abdominal regions is demarcated by the inguinal ligament anteriorly and the ischiopubic ramus of the hip bone medially

Front 12

Describe the leg region.

Back 12

lies between the knees and the rounded medial and lateral prominences that flank the ankle joint, contains tibia (shin bone) and fibula, calf of leg is the posterior prominence caused by the triceps surae muscle from which the calcaneal (Achilles) tendon extends to reach the heel

Front 13

Describe the pelvic girdle.

Back 13

bony ring formed by right and left hip bones and sacrum, these are joined anteriorly at the pubic symphysis, attaches free lower limb to the axial skeleton, sacrum is common to the axial skeleton and pelvic girdle

Front 14

Describe the transfer of weight from the upper body to the lower body.

Back 14

transferred from the vertebral column through the sacroiliac joints to the pelvic girdle and from the pelvic girdle through the hip joints to the femurs, femurs are oblique (inferomedially) so that when standing the knees are adjacent and are placed directly inferior to the trunk, weight from the knee joint is transferred to the ankle joint by tibia, fibula does not articulate with the femur, at the ankle weight goes to talus

Front 15

Describe the hip bone.

Back 15

formed by the fusion of the ilium, ischium and pubis, bones fuse between 15 and 17 years of age and complete by 20-25

Front 16

Describe the ilium.

Back 16

composes the largest part of the hip bone and contributes the superior part of the acetabulum, alae articulates w/ muscles, body joints the pubis and ischium to form the acetabulum, has stout anterior superior and anterior inferior iliac spines that provide attachment for ligaments and tendons of lower limb muscles, beginning at the ASIS the iliac crest extends posteriorly terminating at the posterior superior iliac spine

Front 17

What is the purpose of the iliac crest?

Back 17

serves as a protective bumper and is an important site of aponeurotic attachment for thin, sheet-like muscles and deep fascia

Front 18

What is the importance of the posterior inferior iliac spine?

Back 18

marks the superior end of the greater sciatic notch

Front 19

Describe the ala of the ilium.

Back 19

has three rough curved lines (anterior, posterior and inferior gluteal lines) that demarcate the proximal attachments of the three large gluteal muscles), medially has iliac fossa that provides attachment for the iliac muscle

Front 20

Describe the ischium.

Back 20

forms the posteroinferior part of the hip bone, superior part of the body fuses with the pubis and ilium forming the posteroinferior aspect of the acetabulum, ramus joints the inferior ramus of the pubis to form a bar of bone (ischiopubic ramus), posterior border of the ischium forms the inferior margin of the greater sciatic notch

Front 21

Describe the ischial spine.

Back 21

large triangular, found at the inferior margin of the greater sciatic notch and provides ligamentous attachments, separates the greater sciatic notch from a more inferior, smaller, rounded and smooth surfaced indentation (lesser sciatic notch)

Front 22

What is the importance of the lesser sciatic notch?

Back 22

serves as a trochlea or pully fro a muscle that emerges from the bony pelvis here

Front 23

Describe the ischial tuberosity.

Back 23

rough bony projection at the junction of the inferior end of the body of the ischium and its ramus, body’s weight rests on this tuberosity when sitting and it provides the proximal, tendinous attachment of posterior thigh muscles

Front 24

Describe the pubis.

Back 24

forms the anteromedial part of the hip bone, contributing the anterior part of the acetabulum and provides proximal attachment for muscles of the medial thigh, body of pubis articulates with the corresponding surface of the body of the contralateral pubis by means of the pubic symphysis

Front 25

What structures are formed by the fusion of the two pubis at the pubic symphysis?

Back 25

anterosuperior border of the united bodies and symphysis forms the pubic crest which provides attachment for abdominal muscles, small projections at the lateral ends of this crest (pubic tubercles) are important landmarks of the inguinal regions

Front 26

Describe the obturator foramen.

Back 26

a large oval or irregularly triangular aperture in the hip bone, bounded by the pubis and ischium and their rami, except for a small passageway for the obturator nerve and vessels (obturator canal) the obturator foramen is closed by the thin, strong obturator membrane, hole between superior and inferior pubic rami

Front 27

Describe the obturator membrane.

Back 27

is attachment site for 2 muscles (obturator internis and obturator externis)

Front 28

Describe the anatomical position of the hip bone.

Back 28

1. ASIS and anterosuperior aspect of the pubis lie in the same vertical plane
2. symphysial surface of the pubis is vertical, parallel to the median plane
3. acetabulum faces inferolaterally, with the acetabular notch directed inferiorly
4. obturator foramen lies inferomedial to the acetabulum
5. internal aspect of the body of the pubis faces almost directly superiorly
6. the superior pelvic aperture is more vertical than horizontal, in AP view, the tip of coccyx appears near its center

Front 29

Describe the sacrotuberous ligament.

Back 29

inferiorly the posterior sacroiliac ligament are joined by fibers extending from the posterior margin of th eilium and the base of the coccyx to form the sacrotuberous ligament, massive ligament passes from the posterior ilium and lateral sacrum and coccyx to the ischial tuberosity, transforming the sciatic notch of the hip bone into a large sciatic forament

Front 30

describe the sacrospinous ligament.

Back 30

passes from the lateral sacrum and coccyx to the ischial spine, further subdivides the sciatic forament into greater and lesser sciatic foramen

Front 31

What are the important ligaments of the hip joint?

Back 31

iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament, pass in a spiral fashion from the pelvis to the femur, come from the back and rotate forward and inferior due to embryological development, ligaments of joint capsule tighten in extension and lossen in flexion

Front 32

Describe the iliofemoral ligament

Back 32

anterior and superior, strong, Y shaped, attaches to the anterior inferior iliac spine and the acetabular rim proximally and the intertrochanteric line distally, body’s strongest ligament, prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum

Front 33

Describe the pubofemoral ligament.

Back 33

anterior and inferior, arises from the obturator crest of the pubic bones and passes laterally and inferiorly to merge with the fibrous layer of the joint capsule, blends with the medial part of the iliofemoral ligament and tightens during both extension and abduction of the hip joint, prevents overabduction of the hip joint

Front 34

Describe the ischiofemoral ligament.

Back 34

arises from the ischial part of the acetabular rim, weakest of the three hip ligaments it spiral superolaterally to the femoral neck, medial to the base of the greater trochanter

Front 35

Describe the femur.

Back 35

protrudes from the shaft with an angle (angle varies with age, starts steeper and gets more acute as you age), neck attaches head to shaft (neck is the place where the blood supply of the femur enters, see lots of perforating foramen, supplies the head from this area), longest and heaviest bone in the body, transmits body weight from the hip bone to the tibia when a person is standing, ¼ persons height, consists of shaft and two ends

Front 36

Describe the head of the femur.

Back 36

makes up two thirds of a sphere that is convered with articular cartilage, except for a medially placed depression (fovea for the ligament of the head)

Front 37

Describe the neck of the femur.

Back 37

narrow end supports the head and its broader base is continuous with the shaft, average diameter is three quarters that of the femoral head, proximal femur is bent so that the long axis of the head and neck projects superomedially at an angle to that of the obliquely oriented shaft (angle of inclination)

Front 38

Describe the angle of inclination.

Back 38

greatest (most straight) at birth and gradually diminishes (becomes more acute) until the adult angle is reached (~126), angle is less in females because of the INC width between the acetabula and the greater obliquity of the shaft, allows greater mobility of the femur at the hip joint bec. it places the head and neck more perpendicular to the acetabulum in the neutral position

Front 39

Describe the trochanters of the femur.

Back 39

two bumps, attachment point for muscles, important to know two groups of muscles that attach here (greater-posterior gluteal region, lesser-major hip flexor), where the neck joints the femoral shaft

Front 40

Describe the lesser trochanter.

Back 40

extends medially from the posteromedial part of the junction of the neck and shaft to give tendinous attachment to the primary flexor of the thigh (iliopsoas)

Front 41

Describe the greater trochanter.

Back 41

larger, alterally placed bony mass that projects superiorly and posteriorly where the neck joins the femoral shaft, providing attachment and leverage for abductors and rotators of the thigh

Front 42

What is the intertrochanteric line?

Back 42

where the neck and shaft join, roughened ridged formed by the attachment of a powerful ligament (iliofemoral ligament) that runs from the greater torchter and winds around the lesser trochanter to continue posteriorly and inferiorly as a less distinct ridge (spiral line)

Front 43

What is the intertrochanteric crest?

Back 43

joins the trochanters posteriorly, has a rounded elevation called the quadrate tubercle

Front 44

Describe the shaft of the femur.

Back 44

slightly bowed (convex) anteriorly, smoothly rounded providing fleshy origin to extensors of the knee, except posteriorly where a broad rough line (linea aspera) provides aponeurotic attachment for adductors of the thigh

Front 45

Describe the lateral and medial condyles of the femur.

Back 45

make up nearly the entire inferior end of the femur, are on the same horizontal level when the bone is in its anatomical position, articulate with menisci (crescentic plates of cartilage) and tibial condyles to form the knee joint, articular surface covers the inferior end and then ascends posteriorly, each separated posterily and inferiorly by an intercondylar fossa, merge anteriorly to form patellar surface (articulates with patella)

Front 46

Describe the lateral and medial epicondyles of the femur.

Back 46

places for attachment, medial has a bump called the adductor tubercle (where adductor maguns attaches), lateral epicondyle is a central projection from lateral condyle, medial epicondyle is medial surface of the medial condyle

Front 47

Describe the linea aspera.

Back 47

has two lips (medial and lateral), site of attachment of adductor muscle group, lateral lip blends with gluteal tuberosity, medial lip continues as a narrow, rough spiral line, inferiorly the linea divides into medial and lateral supracondylar lines which lead to the spirally curved medial and lateral condyles

Front 48

What axes are available for movement at the hip joint?

Back 48

1. transverse-extension/flexion
2. AP-abduction/adduction
3. vertical-medial and lateral rotation (isn’t really through the shaft of the femur (straight down through the head to the medial epicondyle region)

Front 49

Describe femoral fractures.

Back 49

the most common type of fracture in femur, femoral neck fracture are especially serious due to possibility of blood supply interruption, spontaneous regression of supply in children = leg calf perthes disease (anterior hip pain), in old people this is a death sentence (head of femur starts to undergo necrosis, bed ridden, get clot), INCingly vulnerable with age esp. in females secondary to osteoporosis, can be transcervical or intertrochanteric, usually occur as a result of indirect trauma (stumbling or stepping down hard), are inherently unstable and impaction

Front 50

Describe femoral fracture of the greater trochanter and femoral shaft.

Back 50

usually result from direct trauma and are most common during the more active years, spiral fracture may occur resulting in foreshortening as the fragments override, or may be comminuted with the fragments displaced in various directions

Front 51

What is the acetabular notch?

Back 51

missing inferior segment of the circle formed by the acetabular rim and lunate surface

Front 52

What is the acetabulr labrum?

Back 52

similar to the glenoid labrum, widens and deepens the joint, almost completely surrounding the head of the femur, attaches to the acetabular rime, INCing the acetabular articular area by nearly 10%, enables the acetabulum to grasp the femoral head

Front 53

What is the transverse acetabular ligament?

Back 53

a continuation of the acetabular labrum, bridges the acetabular notch

Front 54

What is the acetabular fossa?

Back 54

houses the head of the femur, ligament to the head of the femur, formed mainly by the ischium, continuous inferiorly with the acetabular notch

Front 55

What are the different compartments of the thigh?

Back 55

anterior group is innervated by the femoral nerve, medial group by the obturator nerve, posterior group by the sciatic nerve

Front 56

What are the different compartments of the leg?

Back 56

anterior (deep fibular nerve), lateral (superficial fibular nerve), posterior (tibial nerve)

Front 57

Describe the subQ tissue of the lower limb.

Back 57

subQ tissue of hip and thigh is continuous with that of the inferior part of the anterolateral abdominal wall and buttock

Front 58

Describe the lymphatic drainage of the lower limb.

Back 58

concentrated in two sources, both of them go back to the iliac nodes:
1. superficial inguinal nodes which drain to the femoral triangle and femoral canal, converge on and accompany the saphenous veins and their tributaries, pass directly to the external iliac lymph nodes but may also go to deep inguinal lymph nodes
2. back of knee called the popliteal nodes that drain into the deep inguinal nodes, get lymph from vessels accompanying small saphenous vein, also from deep lymphatic vessels

Front 59

Describe the superficial veins of the lower limb.

Back 59

greater and lesser (small) saphenous veins, these are connected to the deep veins of the lower veins by perforating veins, all the vessels in the lower limbs have valves, (superficial, perforators and deep), important bec. there is a column of blood to push up, use valves to milk the blood up, helps reduce the effort needed to move the blood

Front 60

Describe the greater saphenous vein.

Back 60

drains into the region of the femoral triangle and into the femoral vein, superficial drainage, most commonly removed vessel for bypass surgery, travels behind knee and travels to mediate side of foot, formed from the union of the dorsal vein of the great toe and the dorsal venous arch of the foot

Front 61

Describe the course of the greater saphenous vein.

Back 61

1. ascends anterior to the medial amlleolus
2. passes posterior to the medial condyle of the femur (about a hand’s breadth posterior to the medial border of the patella)
3. anastomoses freely with the small saphenous vein
4. traverses the saphnous opening in the fascia lata
5. empties into the femoral vein

Front 62

What veins also enter the greater saphenous vein?

Back 62

lateral and anterior cutaneous arise from networks of veins in the inferior part of the thigh and enter the great saphenous vein superiorly, just before it enters the femoral vein, near its termination also receives the superficial circumflex iliac, superficial epigastric and external pudendal veins

Front 63

Describe the lesser saphenous vein.

Back 63

drains into the popliteal vein, arises on the lateral side of the foot form the union of the dorsal vein of the little toe

Front 64

Describe the course of the lesser saphenous vein.

Back 64

1. ascends posterior to the lateral malleolus as a continuation of the lateral marginal vein
2. passes along the lateral border of the calcaneal tendon
3. inclines to the midline of the fibula and penetrates the deep fascia
4. ascends between the heads of the gastrocnemius muscle
5. empties into the popliteal vein in the popliteal fossa

Front 65

What are perforating veins?

Back 65

penetrate the deep fascia close to their origin from the superficial veins and contain valves that allow blood to flow only from the superficial veins to the deep veins, compression of the perforating veins also prevents blood from flowing from the deep to the superficial veins

Front 66

Describe varicose veins.

Back 66

due to incompetent valve between the superficial and deep vessels, dilated so cusps of their valves do not close, common in posteromedial parts of the lower limb, form when the valves that usually prevent blood flow from the deep veins through the perforating veins to the superficial veins are incompetent and superficial veins become tortuous and dilated, can also occur if perforating vein valves become incompetent

Front 67

Describe the external iliac artery.

Back 67

comes from above the inguinal ligament, crosses underneath the inguinal ligament, once it crosses it becomes femoral artery

Front 68

What is the origin, course and distribution of femoral artery.

Back 68

1. origin-continuation of external iliac artery distal to inguinal ligament
2. course-descends through femoral triangle bisecting it, then courses through adductor canal gaining access to popliteal fossa, terminates as it traverses adductor hiatus, where its name becomes popliteal artery
3. distribution-branches supply anterior and anteromedial aspects of thigh, also gives off deep femoral (profundus femoris)

Front 69

What is the origin, course and distribution of deep artery of thigh?

Back 69

1. origin-femoral artery 1-5 cm inferior to inguinal ligament
2. course-passes deeply between pectineus and adductor longus, descending posterior to latter on medial side of femur
3. distribution-three to four perforating branches pass through adductor magnus muscle, winding around femur to supply muscles in medial, posterior and lateral part of anterior compartments, gives off medial and lateral femoral circumflex that supply the head of femur and wrap around neck of femur

Front 70

What is the origin, course and distribution of the medial circumflex femoral?

Back 70

1. origin-deep artery of thigh, may arise from femoral artery
2. course-passes medially and posteriorly between pectineus and iliopsoas, enters gluteal region and gives rise to posterior retinacular arteries, then terminates by dividing into transverse and ascending branches
3. distribution-supplies most of blood to head and neck of femur, transverse branch takes part in cruciate anastomosis of thigh, ascending branch joins inferior gluteal artery

Front 71

What is the origin, course and distribution of the lateral circumflex femoral artery?

Back 71

1. origin-deep artery of thigh, may arise from femoral artery
2. course-passes laterally deep to Sartorius and rectus femoris, dividing into ascending, transverse and descending arteries
3. distribution-ascending branch supplies anterior part of gluteal region, transverse branch winds around femur, descending branch joins genicular periarticular anastomosis

Front 72

What is the origin, course and distributions of the popliteal artery?

Back 72

1. origin-continuation of femoral artery at adductor hiatus in adductor magnus
2. course-passes through popliteal fossa to leg, ends at lower border of popliteus muscle by dividing into anterior and posterior tibial arteries
3. distribution-superior, middle, and inferior genicular arteries to both lateral and medial aspects of knee

Front 73

What is the origin, course and distributions of the anterior tibial artery?

Back 73

1. origin-popliteal
2. course-passes between tibia and fibula into anterior compartment through gap in superior part of interosseous membrane and descends this membrane between tibialis anterior and extensor digitorum longus
3. distribution-anterior compartment of leg

Front 74

What is the origin, course and distributions of the dorsal artery of the foot?

Back 74

1. origin-continuation of anterior tibial artery distal to inferior extensor retinaculum
2. course-descends anteromedially to first interosseous space and divides into plantar and arcuate arteries
3. distribution-muscles on dorsum of foot, pierces first dorsal interosseous muscles as deep plantar artery to contribute to formation of plantar arch

Front 75

What is the origin, course and distribution of the fibular artery?

Back 75

1. origin-posterior tibial
2. course-descends in posterior compartment adjacent to posterior intermuscular septum
3. distribution-posterior compartment of leg, perforating branches supply lateral compartment of leg

Front 76

What is the origin, course and distribution of the posterior tibial artery?

Back 76

1. origin-popliteal
2. course-passes through posterior compartment of leg and terminates distal to flexor retinaculum by dividing into medial and lateral plantar arteries
3. distribution-posterior and lateral compartments of leg, circumflex compartments of leg, circumflex fibular branch joins anastomoses around knee, nutrient artery passes to tibia

Front 77

Describe cruciate anastomosis.

Back 77

provides collateral circulation around the hip joint, from four vessels:
1. inferior gluteal artery
2. medial femoral circumflex artery
3. lateral femoral circumflex artery
4. 1st perforating branch of the deep femoral artery

Front 78

What is the importance of the cruciate anastomosis?

Back 78

important in lacerations of both the femoral artery and vein, if it is necessary to ligate the femoral artery, anastomosis of branches of the femoral artery with other arteries that cross the hip joint, may supply the lower limb

Front 79

Describe the fascia lata.

Back 79

surrounds the thigh and divides it into three compartments, has components that interdigitate between the muscles, more common in the leg than it is in the thigh, can get compartment syndrome, limits outward expansion of contracting muscles making muscular contraction more efficient, continues inferior to the knee as the deep fascia of the leg, encloses the large thigh muscles

Front 80

Describe the connections of the fascia lata.

Back 80

1. the inguinal ligament, pubic arch, body of pubis, and pubic tubercle superiorly, the membranous layer of subQ tissue (Scarpa fascia) of the inferior abdominal wall also attaches to the fascia latal approx. a finger’s breadth inferior to the inguinal ligament
2. the iliac crest laterally and posteriorly
3. the sacrum, coccyx, sacrotuberous ligament, and ischial tuberosity posteriorly
4. exposed parts of bones around the knee and the deep fascia of the leg distally

Front 81

What is the iliotibial tract/band?

Back 81

lateral thickening of the fascia lata, is the conjoint aponeurosis of the tensor fascia lata and gluteus maximus muscles, extends from the iliac tubercle to the anterolateral tibial tubercle

Front 82

Describe the compartments of the thigh.

Back 82

anterior, medial and posterior, formed by the fascia lata and three fascial intermuscular septa (the lateral intermuscular septum being the strongest) that arise from its deep aspect and attach to the linea aspera of the femur

Front 83

Describe the saphenous opening.

Back 83

moon shaped opening below the inguinal ligament in the fascia lata, defines the boundary where the external iliac becomes the femoral, is a potential spot for hernia, great saphenous vein passes through here and enters the femoral veins, also houses femoral artery and lymphatics, there is a canal medial to these vessels that contains the lymphatics (femoral canal), they enter deep inguinal lymph nodes, invested by continuation of fascia that connects the peritoneum to the wall (transversalis fascia), carried down the thigh to the inguinal ligament, then blends with adventitia of these vessels and with the fascia lata

Front 84

Describe the transversalis fascia.

Back 84

makes ring that house artery, vein and lymphatic, each vessel is septated (septum in between each compartment), lateral two channels are filled, can’t get anything in them, medial channel is femoral canal (femoral ring is the opening)

Front 85

What is in the femoral canal?

Back 85

lymphatics, don’t fill the whole canal so structures can gain access to the thigh, can get intestinal loops into there and get herniation (femoral herniation), more common in women

Front 86

Describe the femoral canal.

Back 86

1. extends distally to the level of the proximal edge of the saphenous opening
2. allows the femoral vein to expand when venous return from the lower limb is INC or when INC intraabdominal pressure causes a temporary stasis in the vein
3. contains loose CT, fat and a few lymphatic vessels and sometimes a deep inguinal lymph node

Front 87

What are the boundaries of the femoral ring?

Back 87

1. laterally-vertical septum between the femoral canal and the femoral vein
2. posteriorly-the superior ramus of the pubis covered by the pectineus and its fascia
3. medially-the lacunar ligament
4. anteriorly-the medial part of the inguinal ligament

Front 88

Describe the femoral sheath.

Back 88

has three components, lateral=femoral artery, medial = femoral vein, medial = femoral canal, femoral nerve lies lateral to the femoral sheat, remember via NAVL, sheath is made of transversalis fascia (inferior prolongation from the abdomen/greater pelvis) which blends with the fascia of the thigh, allows the femoral artery and vein to glide deep to the inguinal ligament during movements of the hip joint

Front 89

Describe femoral hernia.

Back 89

passes thru the canal (lymphatic channel) to protrude in the vicinity of the femoral triangle, appears as a tender mass in the femoral triangle, inferolateral to the pubic tubercle, bounded by the femoral vein and the lacunar ligament, can pass through the saphenous opening into the subQ tissue of the thigh, strangulation may occur because of the sharp, rigid boundaries of the femoral ring

Front 90

Describe the femoral triangle.

Back 90

subfascial space, inferior to the inguinal ligament when the thigh is flexed, abducted and laterally rotated, important for cathetherization for coronary arteries, gain access from femoral vein to right heart

Front 91

What are the boundaries of the femoral triangle?

Back 91

1. superiorly by the inguinal ligament (the thickened inferior margin of the external oblique aponeurosis) that forms the base of the femoral triangle
2. medially by the adductor longus
3. laterally by the sartorius, the apex is where the medial border of the Sartorius crosses the lateral border of the adductor longus
4. floor-iliopsoas laterally and pectineus medially
5. roof-fascia lata and cribriform fascia, subQ tissue and skin

Front 92

What are the contents of the femoral triangle?

Back 92

1. femoral nerve and its (terminal) branches
2. femoral sheath and its contents:
a. femoral artery and several of its branches
b. femoral vein and its proximal tributaries (e.g. the great saphenous and deep femoral veins)
c. deep inguinal lymph nodes and associated lymphatic vessels

Front 93

How does one find the femoral vein?

Back 93

feel pulse of femoral artery and go medial to it, femoral pulse is palpated midway between the ASIS and the pubic symphysis

Front 94

Describe the femoral nerve.

Back 94

L2-L4, largest branch of the lumbar plexus, originates in the abdomen within the psoas major and descends posterolaterally through the pelvis to approx. the midpoint of the inguinal ligament, passes deep to ligament and enters femoral triangle, divides into several branches to the anterior thigh muscles, also articular branches to knee and hip joints, saphenous nerve is terminal cutaneous branch

Front 95

Describe the saphenous nerve.

Back 95

descends through the femoral triangle, lateral to the femoral sheath containing the femoral vessels, accompanies the femoral artery and vein through the adductor canal and becomes superficial by passing between the Sartorius and the gracilis when the femoral vessels traverse the adductor hiatus at the distal end of the canal, runs anteroinferiorly to supply the skin and fascia on the anteromedial aspects of the knee, leg and foot

Front 96

What are the clinical correlations for the femoral artery and vein in the femoral triangle?

Back 96

1. femoral artery-femoral pulse, catheterization (aorta and branch of coronary arteries, mesenteric arteries)
2. femoral vein-catheterization (IVC, right heart and pulmonary circulation)

Front 97

What is the proximal, distal, innervation and main action of the psoas major?

Back 97

1. sides of T12-L5 vertebrae and discs between them, transverse processes of all lumbar vertebrae
2. lesser trochanter of femur
3. anterior rami of lumbar nerves (L1-3)
4. act conjointly in flexing thigh at hip joint and in stabilizing this joint

Front 98

What is the proximal, distal, innervation and main action of the psoas minor?

Back 98

1. sides of T12-L1 vertebrae and intervertebral disc
2. pectineal line, iliopectineal eminence via iliopectineal arch
3. anterior rami of lumbar nerves
4. act conjointly in flexing thigh at hip joint and in stabilizing this joint, does not cross the hip joint

Front 99

what is the proximal, distal, innervation and main action of the iliacus?

Back 99

1. iliac crest, iliac fossa, ala of sacrum and anterior sacroiliac ligaments
2. distal attachment-tendon of psoas major, lesser trochanter, and femur distal to it
3. femoral nerve (L2,3)
4. main action-act conjointly in flexing thigh at hip joint and in stabilizing this joint

Front 100

What is the ilipsoas muscle?

Back 100

formed by the iliacus and psoas major, attaches to lesser trochanter, also see bursa, at the hip joint is the most powerful flexor at the hip joint, innervated by branches of lumbar plexus by femoral nerve

Front 101

Describe the obturator nerve.

Back 101

supplies the medial thigh, L2-4 of the lumbar plexus, comes out of the obturator foramen, runs in the extraperitoneal fat along the lateral wall of the pelvis to the obturator canal, divides into anterior and posterior parts and supplies the medial thigh muscles (adductor muscles), emerges from the medial border of the psas major

Front 102

Describe the femoral nerve.

Back 102

supplies the anterior thigh, L2-4 of lumbar plexus, emerges from the lateral border of the psoas major and innervates the iliacus and passes deep to the inguinal ligament to the anterior thigh, supplying the flexors of the hip and extensors of the knee, arises from L2-4 and supplies the muscles of the anterior thigh gropu as well as the iliopsoas muscle, important for thigh flexion and knee extension

Front 103

What muscles make up the anterior thigh and what is there innervation?

Back 103

1. pectineus-just medial to iliopsoas
2. Sartorius-Tailor’s muscle
3. quadriceps femoris (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)
4. all innervated by the femoral nerve although pectineus can also be innervated by the obturator nerve

Front 104

What is the proximal, distal, innervation and main action of the pectineus?

Back 104

1. superior ramus of pubis
2. pectineal line of femur, just inferior to lesser trochanter
3. femoral nerve, may receive a branch from obturator nerve
4. main action-adducts and flexes thigh, assists with medial rotation of thigh

Front 105

What is the proximal, distal, innervation and main action of the Sartorius?

Back 105

1. ASIS and superior part of notch inferior to it
2. superior part of medial surface of tibia
3. femoral nerve
4. flexes, abducts and laterally rotates thigh at hip joint, flexes leg at knee joint

Front 106

what is the proximal, distal, innervation and main action of the rectus femoris?

Back 106

1. AIIS and ilium superior to acetabulum
2. via common tendinous (quadriceps tendon) and independent attachments to base of patella, indirectly via patellar ligament to tibial tuberosity, medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)
3. femoral nerve
4. extend leg at knee joint, rectus femoris also steadies hip joint and helps iliopsoas flex thigh

Front 107

what is the proximal, distal, innervation and main action of the vastus lateralis?

Back 107

1. greater trochanter and lateral lip of linea aspera of femur
2. via common tendinous (quadriceps tendon) and independent attachments to base of patella, indirectly via patellar ligament to tibial tuberosity, medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)
3. femoral nerve
4. extend leg at knee joint, rectus femoris also steadies hip joint and helps iliopsoas flex thigh

Front 108

what is the proximal, distal, innervation and main action of the vastus medialis?

Back 108

1. intertrochanteric line and medial lip of linea aspera of femur
2. via common tendinous (quadriceps tendon) and independent attachments to base of patella, indirectly via patellar ligament to tibial tuberosity, medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)
3. femoral nerve
4. extend leg at knee joint, rectus femoris also steadies hip joint and helps iliopsoas flex thigh

Front 109

what is the proximal, distal, innervatio and main action of the vastus intermedius?

Back 109

1. anterior and lateral surfaces of shaft of femur
2. via common tendinous (quadriceps tendon) and independent attachments to base of patella, indirectly via patellar ligament to tibial tuberosity, medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)
3. femoral nerve
4. extend leg at knee joint, rectus femoris also steadies hip joint and helps iliopsoas flex thigh

Front 110

What are the flexors of the hip joint?

Back 110

pectineus, psoas minor, psoas major, iliacus, tensor of fascia lata, Sartorius, tensor fascia lata is really a gluteal muscle by innervation but flexes thigh and is seen in anterior compartment

Front 111

What are the vessels and nerves of the anterior thigh?

Back 111

femoral artery, vein and nerve, saphenous nerve, branch of the femoral travels with the artery and vein in adductor canal

Front 112

Describe the adductor canal.

Back 112

passageway in the middle third of the thigh, extends from the apex of the femoral triangle where the Sartorius crosses over the adductor longus to the adductor hiatus, passageway for the femoral artery and vein, saphenous nerve and nerve to vastus medialis, delivers them to the popliteal fossa where they become popliteal vessels

Front 113

What is the definition of the adductor canal?

Back 113

AKA subsartorial canal, Hunter’s canal, the narrow space in the middle third of the thigh between the vastus medialis and adductor muscles, converted into a canal by the overlying Sartorius muscle, it extends from the apex of the femoral triangle to the adductor hiatus (in the tendon of the adductor magnus), it contains the femoral vessels and the saphenous nerve

Front 114

What are the boundaries of the adductor canal?

Back 114

1. anteriorly and laterally by the vastus medialis
2. posteriorly by the adductors longus and magnus
3. medially by the Sartorius which overlies the groove between the above muscles, forming the roof of the canal

Front 115

What is the cutaneous distribution of the femoral nerve?

Back 115

anterior cutaneous branches (from femoral) do anterior thigh, saphenous nerve (from femoral) does anterior/medial leg to medial surface of foot, lateral cutanoues nerve of thigh (which is from L2-3) does lateral aspects of thigh

Front 116

What muscles are the medial compartment?

Back 116

1. adductors-longus, brevis and magnus
2. gracilis
3. obturator externus
4. this group adducts and medially rotates the thigh, innervated by the obturator nerve

Front 117

What is the proximal, distal, innervation and main action of the adductor longus?

Back 117

1. body of pubis inferior to pubic crest
2. middle third of linea aspera of femur
3. obturator nerve
4. adducts thigh

Front 118

What is the proximal, distal, inneravtion and main action nof the adductor brevis?

Back 118

1. body and inferior ramus of pubis
2. pectineal line and proximal part of linea aspera of femur
3. obturator nerve
4. adducts thigh, to some extent flexes it

Front 119

What is the proximal, distal, innervation and main action of the adductor magnus?

Back 119

1. adductor part: inferior ramus of pubis, ramus of ischium, hamstrings part: ischial tuberosity
2. adductor part: gluteal tuberosity, linea aspera, medial supracondylar line, hastrings part: adductor tubercle of femur
3. adductor part: obturator nerve, hamstrings part: tibial part of sciatic nerve
4. adducts thigh, flexes thigh and extends thigh

Front 120

What is the proximal, distal, innervation and main action of the gracilis?

Back 120

1. body and inferior ramus of pubis
2. superior part of medial surface of tibia
3. obturator nerve
4. adducts thigh, flexes leg, helps rotate it medially, can be used to make other muscles

Front 121

what is the proximal, distal, innervation and main action of obturator externus?

Back 121

1. margins of obturator foramen and obturator membrane
2. trochanteric fossa of femur
3. obturator nerve
4. laterally rotates thigh, steadies head of femur in acetabulum

Front 122

Describe the motor branches of the obturator nerve.

Back 122

medial region of thigh-the adductor group is supplied by the obturator nerve, exits the obturator foramen under pectineus and then splits around adductor brevis (forming anterior and posterior divisions), supplies all these muscles giving cutaneous branch to medial thigh

Front 123

Describe the acetabulum.

Back 123

shollow vinegar cup, cup shaped cavity on the lateral aspect of the hip bone that articulates with the head of the femur to form the hip joint, margin of the acetabulum is incomplete inferiorly at the acteabular notch, which makes the fossa resemble a cup with a piece of its lip missing

Front 124

Describe the ossification of pelvis.

Back 124

bones begin to fuse between 15 and 17 years of age, fusion is complete between 20 and 25 years of age, little or no trace of the lines of fusion of the primary bones is visible in older adults, triradiate cartilage, fetus has lots of cartilage space in the region between the acetabulum

Front 125

What muscles arise from the ischium and pubis?

Back 125

innervated by the anterior division nerves

Front 126

What muscles arise from ilium

Back 126

innervated by the posterior division nerves

Front 127

What is the origin, course and distribution of the superior clunial nerve?

Back 127

1. as lateral cutanoues branches of posterior rami of L1-L3
2. pass inferolaterally across iliac crest
3. supply skin of superior buttock as far as tubercle of iliac crest

Front 128

What is the origin, course and distribution of the medial cluenal nerve?

Back 128

1. as lateral cutaneous branches of posterior rami of S1-S3 spinal nerves
2. exit through posterior sacral foramina and pass laterally to gluteal region
3. supply skin over sacrum and adjacent area of buttock

Front 129

What is the origin, course and distribution of the inferior cluneal nerve?

Back 129

1. posterior cutaneous nerve of thigh (anterior rami of S2-S3 spinal nerves)
2. emerges from inferior border of gluteus maximus and ascends superficial to it
3. supplies skin of inferior half of buttock as far as greater trochanter

Front 130

What are the gluteal muscles?

Back 130

1. gluteus maximus
2. gluteus medius
3. gluteus minimus
4. tensor fascia latae
5. TFL has migrated around to the anterior side of the hip joint, collectively the gluteal muscles function like the deltoid does at the shoulder joint, surrounds head of femur capable of lots of actions except adductors

Front 131

what is the proximal, distal, innervation and main action of the gluteus maximus?

Back 131

1. ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberous ligament
2. most fibers end in iliotibial tract (IT band), which inserts into lateral condyle of tibia, some fibers insert on gluteal tuberosity (ilium, sacrum, sacrotuberous ligament, iliotibial tract, gluteal tuberosity of femur)
3. inferior gluteal nerve
4. extends thigh (especially from flexed position) and assists in its lateral rotation, steadies thigh and assists in rising form sitting position, powerful extenders

Front 132

What is the proximal, distal, innervation and main action of the gluteus medius?

Back 132

1. external surface of ilium between anterior and posterior gluteal lines
2. lateral surface of greater trochanter of femur (gluteal surface and lines of ala (wing) of ilium), greater trochanter of femur)
3. superior gluteal nerve
4. abduct and medially rotate thigh, keep pelvis level when ipsilateral limb is weight bearing and advance opposite (unsupported) side during its swing phase, important for postural positions

Front 133

What is the proximal, distal, innervation and main action of the gluteus minimus?

Back 133

1. external surface of ilium between anterior and inferior gluteal lines
2. anterior surface of greater trochanter of femur, (gluteal surface and lines of ala (wing) of ilium), greater trochanter of femur)
3. superior gluteal nerve
4. abduct and medially rotate thigh, keep pelvis level when ipsilateral limb is weight bearing and advance opposite (unsupported) side during its swing phase, important for postural positions

Front 134

What is the proximal, distal, innervation and main action of the tensor of fascia lata?

Back 134

1. ASIS, anterior part of iliac crest
2. iliotibial tract, which attaches to lateral condyle of tibia
3. superior gluteal nerve
4. abduct and medially rotate thigh, keep pelvis level when ipsilateral limb is weight bearing and advance opposite (unsupported) side during its swing phase

Front 135

What is the iliotibial tract?

Back 135

the fibers of the superior and larger part of the gluteus maximus and superficial fibers of the inferior part insert into the iliotibial tract

Front 136

What is the proximal, distal, innervation and main action of the piriformis?

Back 136

1. anterior surface of sacrum, sacrotuberous ligament
2. superior border of greater trochanter of femur
3. branches of anterior rami
4. laterally rotate extended thigh and abduct flexed thigh, steady femoral head in acetabulum

Front 137

Describe the positioning of the piriformis.

Back 137

leaves the pelvis through the greater sciatic foramen, its positioning gives names to vessels and nerves
1. superior gluteal vessels and nerve emerge superior to it
2. inferior gluteal vessels and nerve emerge inferior to it
3. surface marking of the superior border of the piriformis is indicated by a line joining the skin dimple formed by the posterior superior iliac spine to the superior border of the greater trochanter of the femur

Front 138

What is the relationship of the sciatic nerve to the piriformis muscle?

Back 138

sciatic nerve comes underneath the piriformis, sciatic nerve made up of two divisions (tibial portion-anterior, fibular portion-lateral and anterior leg), there are some variations to this, can split and go through the piriformis or can go above and below it, important bec. piriformis can overdevelop and can get piriformis syndrome (compression of sciatic nerve), similar to sciatica

Front 139

Describe proper intragluteal injections.

Back 139

penetrate the skin, fascia and muscles, favorable because the muscles are thick and large, provide a substantial volume for absorption of injected substances by intramuscular veins, be careful of sciatic nerve, safe only in the superolateral quadrant of the buttocks or superior to a line extending from the PSIS to the superior border of the greater trochanter, alos safe in anterolateral part of the thigh where it enters the tensor fascia lata

Front 140

How is this done safely?

Back 140

index finger is placed on the ASIS, and the fingers are spread posteriorly along the iliac crest until the tubercle of the crest is felt by the middle finger, safe in triangular area between the fingers because it is superior to the sciatic nerve, complications can include nerve injury, hematoma, and abscess formation

Front 141

Describe Trendelenburg sign.

Back 141

seen with damage to superior gluteal nerve, gluteus medius and minimus abduct the hip joint on the weight bearing side, denervation of the gluteus medius and gluteus minimus leadsd to an inability to abduct the hip on that side and the unsupported limb sags, compensation places the center of gravity over the supporting lower limb, medial rotation of thigh is severely damaged

Front 142

What does a + trendelenburg sign look like?

Back 142

when a person who has suffered a lesion of the superior gluteal nerve is asked to stand on one leg, the pelvis on the unsupported side descends indicating that the gluteus medius and minimus on the supported side are weak or non-functional, when try to walk, medius and minimus are needed to pick the foot off the ground, if denervated can’t adduct limb and unsupported leg sags, if right is hurt, left drops

Front 143

What else can cause a positive trendelenbrug sign?

Back 143

fracture of the greater trochanter and dislocation of the hip joint

Front 144

what is the course and distribution of the superior gluteal artery?

Back 144

1. course-enters gluteal region through greater sciatic foramen superior to piriformis, divides into superficial and deep branches, anasomoses with inferior gluteal and medial circumflex artereies, comes from internal iliace
2. distribution-superficial branch: supplies gluteus maximus, deep branch: runs between gluteus medius and minimus and supplies them and tensor of fascia lata

Front 145

What is the course and distribution of the inferior gluteal artery?

Back 145

1. course-enters gluteal region through greater sciatic foramen inferior to piriformis, descends on medial side of sciatic nerve, anastomoses with superior gluteal artery and participates in cruciate anastomosis of thigh, involving first perforating artery of deep femoral and medial and lateral circumflex arteries, comes from internal iliac
2. distribution-supplies gluteus maximus, obturator internus, quadratus femoris and superior parts of hamstrings

Front 146

What is the origin, course and distribution of the sciatic nerve?

Back 146

1. origin-sacral plexus (anterior and posterior division of anterior rami of L4-S3)
2. course-enters gluteal region via greater sciatic foramen inferior to piriformis and deep to gluteus maximus, descends in posterior thigh deep to biceps femoris, bifurcates into tibial and common fibular nerves at apex of popliteal fossa
3. distribution-supplies no muscles in gluteal region, supplies all muscles of posterior compartment of thigh (tibial division supplies all but short head of biceps which is supplied by common fibular division)

Front 147

What is the origin, course and distribution of the posterior cutaneous nerve of thigh?

Back 147

1. sacral plexus (anterior and posterior divisions of anterior rami of S1-S3 spinal nerves)
2. enters gluteal region via greater sciatic foramen inferior to piriformis and deep to gluteus maximus, emerging from inferior border of latter, descends in posterior thigh deep to fascia lata
3. supplies skin of inferior half of buttock (through inferior clunial nerves), skin over posterior thigh and popliteal fossa, and skin of lateral perineum and upper media thigh (via its perineal branch)

Front 148

what is the origin, course and distribution of the superior gluteal nerve?

Back 148

1. sacral plexus (posterior divisions of anterior rami of L4-S1)
2. enters gluteal region via greater sciatic foramen superior to piriformis; courses laterally between gluteus medius and minimus as far as tensor of fascia lata
3. innervates gluteus medius, gluteus minimus, and tensor of fascia lata muscels

Front 149

What is the origin, course and distribution of the inferior gluteal nerve?

Back 149

1. sacral plexus (posterior divisions of anterior rami of L5-S2 spinal nerves)
2. enters gluteal region via greater sciatic foramen inferior to piriformis and deep to inferior part of gluteus maximus, dividing into several branches
3. supplies gluteus maximus

Front 150

What is the origin, course and distribution of the nerve to the quadratus femoris?

Back 150

1. sacral plexus (anterior divisions of anterior rami of L4-S1)
2. enters gluteal region via greater sciatic foramen inferior to piriformis, deep (anterior) to sciatic nerve
3. innervates hip joint, inferior gemellus and quadratus femoris

Front 151

What is the origin, course and distribution of the pudendal nerve?

Back 151

1. sacral plexus (anterior divisions of anterior rami of S2-S4)
2. exits pelvis via greater sciatic foramen inferior to piriformis; descends posterior to sacrospinous ligament; enters perineum through lesser sciatic foramen
3. supplies no structures in gluteal region or posterior thigh (principal nerve to perineum)

Front 152

What is the origin, course, and distribution of the nerve ot obturator internus?

Back 152

1. sacral plexus (posterior divisions of anterior rami of L5-S2
2. exits pelvis via greater sciatic foramen inferior to piriformis, descends posterior to sacrospinous ligament, enters perineum through lesser sciatic foramen
3. supplies superior gemellus and obturator internus

Front 153

Describe the short lateral rotator group.

Back 153

all come from sciatic foramen, head out towards the intratrochanteric fossa, include the piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, quadratus femoris (PGOGOQ), innervated mostly by small branches from the lumbosacral plexus

Front 154

What is the proximal, distal, innervation and main action of the obturator internus?

Back 154

1. proximal-pelvic surface of obturator membrane and surrounding bones
2. medial surface of greater trochanter of femur
3. nerve to obturator internus
4. laterally rotate extended thigh and abduct flexed thigh, steady femoral head in acetabulum

Front 155

What is the proximal, distal, innervation and main action of the superior gemellus?

Back 155

1. ischial spine
2. medial surface of greater trochter of femur (trachanteric fossa)
3. nerve to obturator internus
4. laterally rotate extended thigh and abduct flexed thigh, steady femoral head in acetabulum

Front 156

What is the proximal, distal, innervation and main action of the inferior gemellus?

Back 156

1. ischial tuberosity
2. medial surface of greater trochanter of femur (trochanteric fossa)
3. nerve to quadratus femoris
4. laterally rotate extended thigh and abduct flexed thigh, steady femoral head in acetabulum

Front 157

What is the proximal, distal, innervation and main action of the quadratus femoris?

Back 157

1. lateral border of ischial tuberosity
2. quadrate tubercle on intertrochanteric crest of femur and area inferior to it
3. nerve to quadratus femoris
4. laterally rotates thigh, steadies femoral head in acetabulum

Front 158

What are the bony landmarks of posterior thigh muscles?

Back 158

arise from ischial tuberosity (everything except short head of biceps, SITS bone) and lateral supraconyldar line, all but the short head of the biceps cross two joints (hip and knee) include:
1. head of fibula for biceps (lateral muscles)
2. rough area for semimembranous below medial condyle of tibia (medial muscles)
3. tibia along side the tibial tuberosity anteriorly for semitendinous

Front 159

What is the main function of the posterior thigh muscles?

Back 159

flexion at the knee, assists extension of the hip

Front 160

What muscles make up the posterior muscle group of the thigh?

Back 160

1. hamstring muscles-they span 2 joints (hip and knee), semitendinous (half tendon), long head of biceps femoris, semimembranous (half membrane)
2. other muscles-short head of biceps femoris, adductor magnus (hamstring part; forming the adductor hiatus)

Front 161

What is the proximal, distal, innervation and main action of the semitendinous muscle?

Back 161

1. ischial tuberosity
2. medial surface o superior part of tibia
3. tibial division of sciatic nerve
4. extend thigh; flex leg and rotate it medially when knee is flexed, when thigh and leg are flexed, these muscles can extend trunk

Front 162

what is the proximal, distal, innervation and main action of the semimembranosus muscle?

Back 162

1. ischial tuberosity
2. posterior part of medial condyle of tibia, reflected attachment forms oblque popliteal ligament (to lateral femoral condyle)
3. tibial division of sciatic nerve
4. extend thigh; flex leg and rotate it medially when knee is flexed, when thigh and leg are flexed, these muscles can extend trunk

Front 163

What is the proximal, distal, innervation and main action of the biceps femoris?

Back 163

1. long head: ischial tuberosity; short head: linea aspera and lateral supracondylar line of femur
2. lateral side of head of fibula; tendon is split at this site by fibular collateral ligament of knee
3. long head: tibial division of sciatic nerve; short head: common fibular division of sciatic nerve
4. main action-flexes leg and rotates it laterally when knee is flexed; extends thigh

Front 164

What is the innervation to the posterior thigh muscles?

Back 164

sciatic nerve, emerges below the piriformis muscle, is actually two nerves bundled together, splits into the tibial nerve (which innervates all hamstrings except short head, anterior division part) and common peroneal nerve (which innervates short head of the biceps femoris, posterior division part)

Front 165

Why does the short head of the biceps femoris get common peroneal nerve?

Back 165

short head of biceps is far enough around to have gotten the posterior division nerve at development

Front 166

what is the blood supply to the hamstring muscles?

Back 166

blood supply is primarily from the perforating branches of the profunda femoris, there is no big vessel in the posterior compartment of thigh, go through adductor magnus, also continuation of medial and lateral circumflex at the cruciate anastomosis

Front 167

What is the course and distribution of the perforating branch of the profunda femoris?

Back 167

1. enters posterior compartment by perforating aponeurotic porition of adductor magnus attachment and medial intermuscular septum, after providing muscular branches to hamstring, continues on to anterior compartment by piercing lateral intermuscular septum
2. supplies majority of hamstring muscles, then continues to supply vastus lateralis in anterior compartment

Front 168

Describe hamstring strains.

Back 168

pulled and/or torn hamstrings are common in individuals who run and/or kick hard, the violent muscular exertion required to excel in these sports may tear part of the proximal tendinous attachments of the hamstrings to the ischial tuberosity, hamstring strains are twice as common as quadriceps strains

Front 169

What accompanies thigh strains?

Back 169

accompanied by contusion and tearing of muscle fibers, resulting in rupture of the blood vessels supplying the muscles, the resultant hematoma is contained by the dense stocking-like fascia lata, tearing of hamstring fibers is often so painful when the athlete moves or stretches the leg that he or she falls and writhes in pain, often comes from inadequate warming up before practice or competition

Front 170

What can lead avulsion of the ischial tuberosity?

Back 170

occurs at the proximal attachment of the biceps femoris and semitendinosus may result form forcible flexion of the hip with the knee extended

Front 171

What are the borders of the popliteal fossa?

Back 171

1. superolaterally-biceps femoris
2. superomedially by the semimembranosus, laterl to which is the semitendinosus
3. inferolaterally and inferomedially by the alteral and medial heads of the gastrocnemius
4. posteriorly by the skin and popliteal fascia (roof)
5. deep-superior boundaries are formed by the diverging medial and lateral supracondylar lines of the femur

Front 172

What are the contents of the popliteal fossa?

Back 172

1. termination of the small saphenous vein
2. popliteal arteries and veins and their branches and tributaries
3. tibial and common fibular nerves
4. posterior cutaneous nerve of thigh
5. popliteal lymph nodes and lymphatic vessels

Front 173

What are the superficial contents of the popliteal fossa?

Back 173

1. small saphenous vein
2. terminal branches of posterior cutaneous nerve of thigh

Front 174

What are the deep contents of the popliteal fossa?

Back 174

1. popliteal vessels
2. tibial nerve and common fibular nerve (common fibular nerve always wraps around head of fibula)
3. genicular arteries
4. popliteal lymph nodes

Front 175

Describe the popliteal artery.

Back 175

continuation of the femoral artery, begins when the latter passes through the adductor hiatus, passes through the popliteal fossa, divides into anterior tibial artery (anterior to the interosseous membrane) and posterior tibial artery (AKA posterior tibular-fibular trunk), gives off tibio-perioneal trunk

Front 176

Describe the anastomosis around the knee.

Back 176

AKA genicular anastomosis, get supply from five genicular branches of the popliteal artery (superior laterarl, superior medial, middle, inferior lateral and inferior medial genicular arteries), full supply to leg during full knee flexion, also get contributions from the descending genicular branch of the femoral artery, descending branch of the lateral femoral circumflex and anterior tibial recurrent branch of the anterior tibial artery

Front 177

What does the common fibular nerve divide into?

Back 177

superficial fibular and deep fibular nerve, the only muscular nerve supply below knee is sciatic

Front 178

What is the position of the sciatic nerve in the popliteal fossa?

Back 178

from medial to lateral it is artery, vein, nerve (easy to remember lateral because the nerve gives off common peroneal (fibular) which wraps around the head of the fibular)

Front 179

Describe popliteal cysts.

Back 179

are fluid filled herniations of the synovial membrane of the knee joint, baker’s cyst, can cause problems and pain

Front 180

Describe tibia.

Back 180

located on the anteromedial side of the leg, second largest bone in the body, flares outward at both ends to provide an INC area for articulation, has medial and lateral condyles forming a flat superior articular surface (tibial plateau)

Front 181

What is the importance of the tibial plateau?

Back 181

consists of two smooth articular surfaces, medial one is slightly concave lateral is convex, articulate with the large condyles of the femur, separated by an intercondylar eminence formed by two intercondylar tubercles

Front 182

Describe the tibial tuberosity.

Back 182

found at the superior end of the anterior border, provides distal attachment for the patellar ligament, which stretches between the inferior margin of the patella and the tibial tuberosity

Front 183

Describe the medial malleolus.

Back 183

medial expansion of the distal end of the tibia, inferior surface of the shart and the lateral surface of the medial malleolus articulate with the talus and are covered with articular cartilage, muscles that pass anterior to the malleolus are dorsiflexors and muscles that pass posterior are plantar flexors

Front 184

Describe the interosseous border of the tibia.

Back 184

is sharp where it gives attachment to the interosseous membrane that unites the two leg bones

Front 185

Describe the fibular notch.

Back 185

groove that replaces the sharp border, accommodates and provides fibrous attachment to the distal end of the fibula

Front 186

Describe the fibula.

Back 186

slender, lies posterolateral to the tibia and is firmly attached to it by the tibiofibular syndesmosis which includes the interosseous membrane, leg is fixed in a permanently pronated position that places the greater toe medially and directs the sole of the foot inferiorly toward the ground, has no function in weight bearing, serves mainly for muscle attachment

Front 187

describe the lateral malleolus of the fibula.

Back 187

distal end of fibula is prolonged laterally and inferiorly as the lateral malleolus, forms the outer walls of a rectangular socket which is the superior component of the ankle joint, more prominent and posterior than the medial malleolus and extends approx. 1 cm more distally, muscles that pass anterior to the malleolus are dorsiflexors and muscles that pass posteriorly are plantar flexors

Front 188

What are the bones of the foot?

Back 188

include the tarsus (7), metatarsus (5), and phalanges (14)

Front 189

Describe the tarsus.

Back 189

consists of seven bones (talus, calcaneus, cuboid, navicular and three cuneiforms, only talus articulate with the leg bones, trochlea of the talus is gripped by the two malleoli and receives the weight of the body from the tibia

Front 190

Describe the calcaneus.

Back 190

heel bone, largest and strongest bone in the foot, transmits the majority of the body’s weight from the talus to the ground

Front 191

Describe the metatarsus.

Back 191

consists of five bones, 1st is shorter and stouter than the others, 2nd is longest

Front 192

Describe the phalanges.

Back 192

14 of them, 1st digit has 2 phalanges (proximal and distal) and the other four have 3 phalanges (proximal, middle, distal), has a base, shaft and head

Front 193

What are the fascial compartments of the leg?

Back 193

very strong, very well defined, crural fascia covers it, denser than fascia lata but not as dense as IT band
1. anterior-between tibia and fibula
2. lateral-made up of only two muscles
3. posterior superficial-
4. posterior deep-

Front 194

Describe anterior compartment of the leg.

Back 194

dorsiflexor (extensor) compartment, located anterior to the interosseous membrane between the lateral surface of the tibial shaft and the medial surface of the fibular shaft and anterior to the intermuscular septum that connects them, bounded anteriorly by the deep fascia of the leg and skin, most susceptible to compartment syndromes

Front 195

What are the tow bands-like thickenings of fascia that form retinacula in the anterior compartment?

Back 195

1. superior extensor retinaculum-is a strong, broad band of deep fascia, passing from the fibula to the tibia, proximal to the malleoli
2. inferior extensor retinaculum-a Y-shaped band of deep fascia, attaches laterally to the anterosuperior surface of the calcaneus, it forms a strong loop around the tendons of the fibularis tertius and the extensor digitorum longus muscles

Front 196

Describe the posterior compartment of the leg.

Back 196

largest of the three leg compartments, divided into superficial and deep subcompartments/muscle groups by the transverse intermuscular septum, the tibial nerve and posterior tibial and fibular vessels supply both parts of the posterior compartment but run in the deep subcaompartment deep to the transverse intermuscular septum

Front 197

What movements do the posterior compartment muscles of the leg allow?

Back 197

produce plantarflexion at the ankle, inversion at the subtalar and transverse tarsal joints and flexion of the toes

Front 198

Describe the lateral compartment of the leg.

Back 198

smallest of the leg compartments, bounded by the lateral surface of the fibula, the anterior and posterior intermuscular septa and the deep fascia of the leg, ends inferiorly at the superior fibular retinaculum, which spans between the distal tip of the fibula and the calcaneus

Front 199

Describe the Achilles tendon.

Back 199

three muscles contribute to the calcaneal (Achilles) tendon, this tendon attaches to the tuberosity of the calcaneus, includes gastrocnemius, soleus, and plantaris, attaches to the calcaneus, if rupture takes a year to repair

Front 200

What are the superficial muscles of the posterior crucial compartment?

Back 200

1. gastrocnemius (lateral and medial heads)-femoral condyles to calcaneal tendon
2. soleus-superior posterior part of tibia and fibula to calcaneal tendon
3. triceps surae-combination of two heads of gastrocnemius and head of soleus
4. plantaris (often absent)-lateral condyle of femur to calcaneal tendon

Front 201

What is the proximal, distal, innervation and main action of the gastrocnemius?

Back 201

1. lateral head-lateral aspect of lateral condyle of femur; medial head-popliteal surface of femur, superior to medial condyle
2. posterior surface of calcaneous via calcaneal tendon
3. tibial nerve
4. platraflexes ankle when knee is extended, raises heel during walking, flexes leg at knee joint, stand on toes

Front 202

What is the proximal, distal, innervation and main action of the soleus?

Back 202

1. posterior aspect of superior quarter of fibula, soleal line and middle third of medial border of tibia and tendinous arch extending between bony attachments
2. posterior surface of calcaneous via calcaneal tendon
3. tibial nerve
4. plantarflexes ankle independently of position of knee, steadies leg on foot, does not cross knee joint

Front 203

What is the proximal, distal, innervation and main action of the plantaris?

Back 203

1. inferior end of lateral supracondylar line of femur, oblique popliteal ligament
2. posterior surface of calcaneous via calcaneal tendon
3. tibial nerve
4. weakly assists gastrocnemius in plantarflexing ankle

Front 204

What are the deep muscles of the posterior crural compartment?

Back 204

1. popliteus-lateral femoral condyle to posterior tibia
2. flexor hallucis longus (FHL)-fibula and interosseous membrane to digit 1
3. flexor digitorum longus (FDL)-tibia to digits 2-5
4. tibialis posterior (TP)-interosseous membrane to bases of tarsal and metatarsal bones, tendon behind malleolus, attaches to metatarsal

Front 205

Describe the Tom, Dick and Harry muscles.

Back 205

found in the deep posterior compartment and anterior compartment, three muscles found in the compartments, as they cross the medial malleolus can see there bundle in order (Tom, Dick and (artery and nerve) Harry)

Front 206

What is the proximal, distal, innervation and main action of the popliteus?

Back 206

1. lateral surface of lateral condyle of femr and lateral meniscus
2. posterior surface of tibia superior to soleal line
3. tibial nerve
4. weakly flexes knee and unlocks it by rotating femur 5 degrees

Front 207

What is the proximal, distal, innervation and main action of the FHL?

Back 207

1. inferior two thirds of posterior surface of fibula, inferior part of interosseous membrane
2. base of distal phalanx of great toe (hallux)
3. tibial nerve
4. flexes great toe at all joints; weakly plantarflexes ankle, supports medial longitudinal arch of foot

Front 208

What is the proximal, distal, innervation and main action of the FDL?

Back 208

1. medial part of posterior surface of tibia inferior to soleal line, by a braod tendon to fibula
2. bases of distal phalanges of lateral four digits
3. tibial nerve
4. flexes lateral four digits, platnarflexes ankle, supports longitudinal arches of foot

Front 209

What is the proximal, distal, innervation and main action of the tibialis posterior?

Back 209

1. interosseous membrane; posterior surface of tibia inferior to soleal line, posterior surface of fibula
2. tuberosity of navicular, cuneiform, cuboid, and talar shelf of calcaneus bases of 2nd, 3rd and 4th metatarsals
3. tibial nerve
4. plantarflexes ankle, inverts foot

Front 210

Describe the posterior tibial artery.

Back 210

larger and more direct terminal branch of the popliteal artery, provides blood supply to the posterior compartment of the leg, begins at distal border of the popliteus as the popliteal artery passes deep to the tendinous arch of the soleus, gives rise to its largest branch the fibular artery which runs lateral and parallel to it, accompanied by the tibial nerve and veins, psoerior to the medial malleolus, between the tendons of the FDL and FHL, deep to flexor retinaculum, divides into medial and lateral plantar arteries

Front 211

Describe the tibial nerve.

Back 211

the larger of the two terminal branches of the sciatic nerve, runs vertically through the popliteal fossa with the popliteal artery, passing between the heads of the gastrocnemius, supplies all muscles in the posterior compartment of the leg, lies between the tendons of the FHL and FDL

Front 212

What are the anterior compartment muscles?

Back 212

1. tibialis anterior-from tibia and interosseous membrane to medial cuneiform and 1st metatarsal, dorsiflexes ankle and inverts foot
2. extensor digitorum longus-from tibia and fibula and interosseous membrane to phalanges of digits 2-5
3. extensor hallucis longus-from middle fibula and interosseous membrane to distal phalanx of digit 1 (hallux), extends great toe and dorsiflexes foot
4. fibularis tertius-inferior fibula and interosseous membrane to 5th metatarsal, everts and dorsiflexes foot, inversion sprain can break 5th metatarsal

Front 213

what is the proximal, distal, innervation and main action of the tibialis anterior?

Back 213

1. lateral condyle and superior half of lateral surface of tibia and interosseous membrane
2. medial and inferior surfaces of medial cuneiform and base of 1st meatarsal
3. deep fibular nerve
4. dorsiflexes ankle and inverts foot

Front 214

What is the proximal, distal, innervation and main action of the extensor digitorum longus?

Back 214

1. lateral condyle of tibia and superior three quarters of medial surface of fibula and interosseous membrane
2. middle and distal phalanges of lateral four digits
3. deep fibular nerve
4. extends lateral four digits and dorsiflexes ankle

Front 215

What is the proximal, distal, innervation and main action of the extensor hallucis longus?

Back 215

1. middle part of anterior surface of fibula and interosseous membrane
2. dorsal aspect of base of distal phalanx of great toe
3. deep fibular nerve
4. extends great toe and dorsiflexes ankle

Front 216

What is the proximal, distal, innervation and main action of the fibularis tertius?

Back 216

1. inferior third of anterior surface of fibula and interosseous membrane
2. dorsum of base of 5th metatarsal
3. deep fibular nerve
4. dorsiflexes ankle and aids in eversion of foot

Front 217

What are the muscles of the lateral compartment?

Back 217

1. fibularis longus-has extensive insertion to the plantar surface of foot to first metatarsal, makes sling with tibialis anterior muscle
2. fibularis brevis-

Front 218

what is the proximal, distal, innervation and main action of the fibularis longus?

Back 218

1. head and superior two thirds of lateral surface of fibula
2. base of 1st metatarsal and medial cuneiform
3. superficial fibular nerve
4. everts foot and weakly plantarflexes ankle

Front 219

what is the proximal, distal, innervation and main action of the fibularsi brevis?

Back 219

1. inferior two thirds of lateral surface of fibula
2. dorsal surface of tuberosity on lateral side of base of 5th metatarsal
3. superficial fibular nerve
4. everts foot and weakly plantarflexes ankle

Front 220

What is the innervation to the lateral and anterior compartments of the leg?

Back 220

peroneal (fibular) nerve divides into superficial (lateral compartment) and deep (anterior compartment, Tom, Dick and Harry muscles), knee down is all sciatic

Front 221

Describe the blood supply to the leg.

Back 221

the superficial femoral supplies blood to the leg, behind the knee it is called the popliteal, but it divides into the anterior tibial (anterior compartment) and posterior tibial (posterior compartment and foot where it gives rise to arch) in the leg (clinically referred to as the tib-peroneal trunk), main supply below the knee is femoral which becomes popliteal, anterior tibial goes through interosseous membrane to get to anterior compartment

Front 222

Describe the anterior tibial artery.

Back 222

supplies structures in the anterior compartment, is a terminal branch of the popliteal artery, begins at inferior border of the popliteus muscle and immediately passes anteriorly through a gap in the superior part of the interossesous membrane to descend on the anterior surface of this membrane between the TA and EDL muscles, becomes the dorsal artery of the foot at the ankle joint

Front 223

Describe the blood supply to the lateral compartment.

Back 223

gets blood from perforating branches of the anterior tibial artery that penetrate the anterior intermuscular septum, also gets peroneal branch from the posterior tibial that supplies the lateral compartment

Front 224

Describe the tendon sheaths and retinacula of the foot.

Back 224

superior and inferior extensor retinacula and peroneal retinacula, hold the tendons in place, synovial tendon sheaths to make sure that the tendons don’t wear out

Front 225

What is the purpose of the flexor retinaculum?

Back 225

holds the Tom, Dick and Harry muscles in place

Front 226

What muscles are in the 1st layer of plantar muscles?

Back 226

1. flexor digitorum brevis (digits 2-5)
2. abductor hallucis
3. abductor digiti minimi

Front 227

What is the proximal, distal, innervation and main action of the abductor hallucis?

Back 227

1. medial tubercle of tuberosity of calcaneus, flexor retinaculum, plantar aponeurosis
2. medial side of base of proximal phalanx of 1st digit
3. medial plantar nerve
4. abducts and flexes 1st digit

Front 228

What is the proximal, distal, innervation and main action of the flexor digitorum brevis?

Back 228

1. medial tubercle of tuberosity of calcaneus, plantar aponeuorsis, intermuscular septa
2. both sides of middle phalanges of lateral four digits
3. medial plantar nerve
4. flexes lateral four digits

Front 229

What is the proximal, distal, innervation and main action of the abductor digiti minimi?

Back 229

1. medial and lateral tubercles of tuberosity of calcaneus, plantar aponeurosis, intermuscular septa
2. lateral side of base of proximal phalanx of 5th digit
3. lateral plantar nerve
4. abducts and flexes little toe

Front 230

What muscles make up the 2nd layer of plantar muscles?

Back 230

1. quadratus plantae
2. lumbriclas to digits 2-5
3. basically the muscles attached to the two long tendons

Front 231

What is the proximal, distal, innervation and main action of quadratus plantae?

Back 231

1. medial surface and lateral margin of plantar surface of calcaneus
2. posterolateral margin of tendon of flexor digitorum longus
3. lateral plantar nerve
4. assists flexor digitorum longus in flexing lateral four digits (toes)

Front 232

What is the proximal, distal, innervation and main action of the lumbricals?

Back 232

1. tendons of flexor digitorum longus
2. medial aspect of expansion over lateral four digits
3. medial one: medial plantar nerve; lateral three-lateral plantar nerve
4. flex proximal phalanges, extend middle and distal phalanges of lateral four digits

Front 233

what muscles make up the 3rd layer of plantar muscles?

Back 233

1. flexor hallucis brevis-2 heads with sesamoid bones
2. adductor hallucis-2 heads
3. flexor digiti minimi

Front 234

What is the proximal, distal, innervaiton and main action of the flexor hallucis brevis?

Back 234

1. plantar surfaces of cuboid and lateral cuneiforms
2. both sides of base of proximal phalanx of 1st digit
3. medial plantar nerve
4. flexes proximal phalanx of 1st digit

Front 235

What is the proximal, distal, innervation and main action of the adductor hallucis?

Back 235

1. oblique head-bases of metatarsals 2-4; transverse head-plantar ligaments of metatarsophalangeal joints
2. tendons of both heads attach to lateral side of base of proximal phalanx of 1st digit
3. deep branch of lateral plantar nerve
4. traditionally said to adduct 1st digit; assists in transverse arch of foot by metatarsal medially

Front 236

what is the proximal, distal, innervation and main action of the flexor digiti minimi brevis?

Back 236

1. base of 5th metatarsal
2. base of proximal phalanx of 5th digit
3. superficial branch of lateral plantar nerve
4. flexes proximal phalanx of 5th digit thereby assisting with its flexion

Front 237

What muscles make up the 4th layer of plantar muscles = interossei muscles of the foot?

Back 237

1. abduction-4 dorsal interosseous muscles (DAB)
2. adduction-3 plantar interosseous muscles (PAD)

Front 238

What is the proximal, distal, innervaiton and main action of the plantar interossei muscles?

Back 238

1. bases and medial sides of metatarsals 3-5
2. medial sides of bases of phalanges of 3rd-5th digits
3. lateral plantar nerve
4. adducts digits (2-4) and flex metatrsophalangeal joints

Front 239

What is the proximal, distal, innervation and main action of the dorsal interossei muscles?

Back 239

1. adjacent sides of metatarsals 1-5
2. 1st-medial side of proximal phalanx of 2nd digit; 2nd-4th-lateral sides of 2nd-4th digits
3. lateral plantar nerve
4. abduct digits (2-4) and the metatarsalphalangeal joints

Front 240

What muscles make up the intrinsic foot muscles (dorsal side)?

Back 240

1. extensor hallucis brevis
2. extensor digitorum brevis
3. both of these muscles are innervated by the deep peroneal nerve

Front 241

What is the proximal, distal, innervation and main action of the extensor digitorum brevis?

Back 241

1. calcaneus; interosseous talocalcaneal ligament; stem of inferior extensor retinaculum
2. long extensor tendons of four medial toes
3. deep fibular nerve
4. aids the extensor digitorum longus in extending the four medial toes at the metatarsophalangeal and interphalangeal joints

Front 242

What is the proximal, distal, innervation and main action of the extensor hallucis brevis?

Back 242

1. in common with extensor digitorum brevis
2. dorsal aspect of base of proximal phalanx of great toe
3. deep fibular nerve
4. aids the extensor hallucis longus in extending the great toe at the metatarsophalangeal joint

Front 243

What is the nerve supply of the plantar foot muscles?

Back 243

1. lateral plantar nerve-like the ulnar, all intrinsic muscles except the thenar equivalents, the lumbricals to the functional midline on the medial side and the flexor digitorum brevis (like the flexor digitorum superficialis
2. medial plantar nerve-innervates the above named exceptions, like the median nerve

Front 244

What is the origin, coruse and distribution of the saphenous nerve?

Back 244

1. origin-femoral nerve
2. course-arises in femoral triangle and descends through thigh and leg, accompanies great saphenous vein anterior to medial mallolus, ends on medial side of foot
3. supplies the skin on medial side of foot as far anteriorly as head of 1st metatarsal

Front 245

What is the origin, course, and distribution of the superficial fibular nerve?

Back 245

1. origin-common fibular nerve
2. course-peirces deep fascia in distal third of leg to become cutaneous, then sends branches ot foot and digits
3. supplies skin on dorsum of foot and all digits, except lateral side of 5th and adjoining sides of the 1st and 2nd digits

Front 246

what is the origin, course and distribution of the deep fibular nerve?

Back 246

1. origin-common fibular nerve
2. course-passes deep to extensor retinaculum to enter dorsum of foot
3. supplies extensor digitorum brevis an skin on contiguous sides of 1st and 2nd digits

Front 247

What is the origin, course and distribution of the medial plantar nerve?

Back 247

1. origin-larger terminal branch of tibial nerve
2. passes distally in foot between abductor hallucis and flexor digitorum brevis; divides into muscular and cutanoues branches
3. supplies skin of medial side of sole of foot and sides of first three digits, also supplies abductor hallucis, flexor digitorum brevis, flexor hallucis brevis and first lumbrical

Front 248

What is the origin, course and distribution of the lateral plantar nerve?

Back 248

1. smaller terminal branch of tibial nerve
2. passes laterally in foot between quadratus plantae and flexor digitorum brevis muscles; divides into superficial and deep branches
3. supplies quadratus plantea, abductor digiti minimi, digit minimi brevis, deep branch supplies plantar and dorsal interossei, lateral three lumbricals and adductor hallucis, supplies skin on sole lateral to a line splitting 4th digit

Front 249

Describe the blood supply to the foot.

Back 249

the anterior tibial artery continues into the dorsum of the foot and becomes the dorsalis pedis, the lateral plantar artery forms the plantar arch, are terminal branches of the anterior and posterior tibial arteries forming the dorsal and plantar arteries

Front 250

Describe the dorsalis pedis.

Back 250

easily accessible, use for pulse and blood gases, contributes to the arch of the foot and dorsal digital branches, also deep plantar artery branch that hooks up with the arch on the plantar arch (lateral plantar is what gives most to the plantar arch)

Front 251

Describe the dorsal artery of the foot.

Back 251

often a major source of blood supply to the forefoot, direct continuation of the anterior tibial artery, begins midway between the malleoli and runs anteromedially deep to the inferior extensor retinaculum between the extensor hallucis longus and the extensor digitorum longus tendons on the dorsum of the foot

Front 252

What are the divisions of the dorsal artery of the foot?

Back 252

divides into the 1st dorsal metatarsal artery and a deep plantar artery, deep plantar artery joints the lateral plantar artery to form the deep plantar arch, also has lateral tarsal, 1st-4th dorsal metatarsal and arcuate artery branches

Front 253

Describe the dorsal pedis pulse.

Back 253

the pulse of the dorsal artery of the foot, feet are slightly dorsiflexed, dorsal arteries of the foot are subQ and pass along a line from the extensor retinaculum to a point just lateral to the EHL tendons, dimished pulse usually suggests vascular insufficiency

Front 254

What are the 5 P signs?

Back 254

pain, pallor, paresthesia, paralysis and pulselessness

Front 255

Describe the medial plantar artery.

Back 255

smaller terminal branch of the posterior tibial artery, gives rise to deep branch that supplies mainly muscles of the great toe, superficial branch supplies skin on medial side of sole, occasionally a superifical plantar arch is formed when the superficial branch anastomoses with the lateral plantar artery or the deep plantar arch

Front 256

Describe the lateral plantar artery.

Back 256

much larger than the medial, deep to the adductor hallucis and then vbetween the flexor digitorum brevis and quadratus plantae, arches medially across the foot with the deep branch of the lateral plantar nerve to form the deep plantar arch which is completed by union with the deep plantar artery

Front 257

Describe the deep plantar arch.

Back 257

as it crosses the foot, gives four plantar metatarsal arteries, three perforating branches and many branches to the skin, fascia and muscles in the sole

Front 258

Describe the plantar digital arteries.

Back 258

formed from the division of the plantar metatarsal arteries, supply the adjacent digits, provide most of the blood reaching the distal toes, including nail beds

Front 259

Describe the cutaneous nerve supply (dorsal)

Back 259

common fibular nerve divides into:
1. superficial fibular (peroneal) nerve (dorsal digital branches), after it innervates anterior compartment it innervates the dorsum of the foot
2. deep fibular (peroneal) nerve (dorsal digital branch (digits1/2))
3. sural nerve-combo of two branches of the tibial posteriorly

Front 260

Describe the cuteanous nerve supply on the plantar side.

Back 260

includes tibial, sural, saphenous, lateral plantar and medial plantars, most is off of the tibial, some off saphenous, some off sural, 3.5 is medial plants, 1.5 is lateral plantar

Front 261

Describe injury to the common fibular nerve.

Back 261

get footdrop, common fibular nerve divides into superficial fibular nerve and deep fibular nerve

Front 262

Describe the ankle joint.

Back 262

talocrural articulation, hinge type of synovial joint, the distal ends of th tibia and fibula form a malleolar mortise into which the pulley shaped trochlea of the talus fits

Front 263

Describe the articulations of the ankle joint.

Back 263

1. medial surface of the lateral malleolous articulates with the lateral surface of the talus
2. tibia articulates with the talus in two places:
a. its inferior surface forms the roof of the malleolus mortise, transferring the body’s weight to the talus
b. its medial malleolus articulates with the medial surface of the talus\

Front 264

Describe the grip of the malleolus on the trochlea.

Back 264

grips is strongest during dorsiflexion because this movement forces the wider, anterior part of the trochlea posteriorly between the malleoli, spreading the tibia and fibula slightly apart, this spreading is limited especially by the strong interosseous tibiofibular ligament as well as the anterior and posterior tibiofibular ligaments that unite the tibia and fibula, ankle joint is relatively unstable during plantarflexion because the trochlea is narrower posteriorly and therefore lies relatively loosely within the mortise, it is during plantarflexion that most injuries occur

Front 265

Describe the anterior tibiofibular ligament.

Back 265

strengthens the superior tibiofibular joint, connects the tibia and fibula, there is a superior and inferior one

Front 266

What is the sustentaculum tali and fibular retinacula?

Back 266

hold 3 and 2 tendons respectively

Front 267

Describe the posterior tibiofibular ligament.

Back 267

also strengthens the tibiofibular joint

Front 268

What is the lateral ligament of the ankle?

Back 268

stabilizes the ankle joint laterally, consists of anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament

Front 269

Describe the anterior talofibular ligament.

Back 269

a flat, weak band that extends anteromedially from the lateral malleolus to the neck of the talus

Front 270

Describe the posterior talofibular ligament.

Back 270

a thick, fairly strong band that runs horizontally medially and slightly posteriorly from the malleolar fossa to the lateral tubercle of the talus

Front 271

Describe the calcaneofibular ligament.

Back 271

a round cord that passes posteroinferiorly form the tip of the lateral malleolus to the lateral surface of the calcaneus

Front 272

What is the medial (deltoid) ligament?

Back 272

reinforces the ankle joint medially, attaches proximally to the medial malleolus, fans out from the malleolus, attaching distally to the talus, calcaneus and navicular via four adjacent and continuous parts (tibionavicular part, tibiocalcaneal part and anterior and posterior tibiotalar parts), stabilizes the ankle joint during eversion and prevents subluxation of the joint

Front 273

What are the joints of inversion and eversion?

Back 273

subtalar joint, transverse tarsal joint (calcaneocuboid joint), tarsometatarsal joint

Front 274

Describe the subtalar joint.

Back 274

the inferior surface of body of talus articulates with superior surface of calcaneus, allows for inversion and eversion

Front 275

Describe the transverse tarsal (calcaneocuboid) joint.

Back 275

anterior end of calcaneus articulates with posterior surface of cuboid, allows for inversion and eversion of foot, circumduction

Front 276

Describe the tarsometatarsal joint.

Back 276

anterior tarsal bones articulate with bases of metatarsal bones, allows for gliding or sliding movements

Front 277

Describe an ankle sprain.

Back 277

torn fibers of ligaments, is nearly always an inversion injury involving twisting of the weight bearing plantarflexed foot, lateral ligament sprains occur in sports in which running and jumping are common, lateral is much weaker than medial and anterior talofibular ligament is normally torn during ankle sprains

Front 278

Describe Pott fracture-dislocation of the ankle.

Back 278

eversion injury, this action pulls on the extremely strong medial ligament often tearing off the medial malleolus, talus moves laterally, shearing off the lateral malleolus or breaking the fibula superior to the tibiofibular syndesmosis,

Front 279

What is a trimalleolar fracture?

Back 279

occurs if the tibia is carried anteriorly the posterior margin of the distal end fo the tibia is also sheared off by the talus, the entire distal end fo the tibia is erroneously considered to be a malleolus

Front 280

What are the arches of the foot?

Back 280

include the longitudinal and transverse arch, resilient arches adapt foot to weight and surface changes

Front 281

Describe the longitudinal arch of the foot.

Back 281

is composed of medial and lateral parts:

Front 282

Describe the medial longitudinal arch.

Back 282

medial longitudinal arch-is higher and more important than the lateral longitudinal, composed of the calcaneus, talus, navicular, three cuneiforms and three metatarsals, the talar head is the keystone of the medial longitudinal arch, the tibialis anterior, attaching to the 1st metatarsal and medial cuneiform, helps strengthen the medial longitudinal arch, the fibularis longus tendon also helps support this arch, most interlocking bones contribute

Front 283

Describe the lateral longitudinal arch.

Back 283

is much flatter than the medial part and rests on the ground during standing, made up of the calcaneous, cuboid and lateral two metatarsals

Front 284

Describe the force transmission of the longitudinal arch.

Back 284

tibia -> talus -> posteroinferiorly to calcaneus and anteroinferiorly to heads of metatarsals (predominantly to first)

Front 285

What is the ligamentous support to the longitudinal arch?

Back 285

1. plantar aponeurosis
2. plantar ligament
3. plantar calcaneonavicular (= spring) ligament
4. other plantar ligaments (short and long plantar)
5. tendon of fibularis longus

Front 286

Describe the transverse arch of the foot.

Back 286

runs from side to side, formed by the cuboid, cuneiforms, and bases of the metatarsals, the medial and lateral parts of the longituindal arch serve as pillars for the transverse arch, the tendons of the fibularis longus and tibilais posterior help maintain the curvature of the transverse arch

Front 287

Describe flatfoot (pes planus)

Back 287

normal to have flatfeet before age 3 due to thick fat pad in the sole, can be flexible (flat, lacking a medial arch when weight bearing but normal when not weight bearing) or rigid (flat even when not weight bearing), flatfeet are common in older people particularly if they undertake much unaccustomed standing or gain weight rapidly

Front 288

Describe the knee joint.

Back 288

is our largest and most superficial joint, allows flexion and extension, fibula is not involved in the knee joint

Front 289

What are the femur parts involved in the knee joint?

Back 289

1. adductor tubercle
2. lateral epicondyle and condyle
3. medial epicondyle and condyle
4. intercondylar fossa

Front 290

What are the tibia parts involved in the knee joint?

Back 290

1. intercondylar eminence-fits into intercondylar fossa of femur
2. lateral and medial condyle
3. tibial tuberosity

Front 291

What are the fibular parts involved in the knee joint?

Back 291

head and neck

Front 292

Describe the articulations fo the knee joint.

Back 292

1. two femorotibial articulations (lateral and medial) between the lateral and medial femoral and tibial condyles
2. one intermediate femoropatellar articulation between the patella and the femur

Front 293

What is the fabella?

Back 293

sesamoid bone commonly found in lateral head of gastrocnemius muscle

Front 294

What are the ligaments of the knee joint?

Back 294

1. tibial collateral ligament
2. fibular collateral ligament-with relation to popliteus tendon
3. anterior cruciate ligament
4. posterior cruciate ligament
5. posterior meniscofemoral ligament

Front 295

Describe the tibial collateral ligament.

Back 295

AKA TCL, MCL, is a strong, flat, intrinsic band that extends from the medial epicondyle of the fmur to the medial condyle and the superior part of the medial surface of the tibia, at its midpoint, the deep fibers oft eh TCL are firmly attaches to the medial meniscus, the TCL, weaker than the FCL, is more often damaged, as a result, the TCL and medial meniscus are commonly torn during contact sports such as football and ice hockey

Front 296

Describe the fibular collateral ligament.

Back 296

AKA FCL, LCL, a cord-like extracapsular ligament, is strong, it extends inferiorly from the ltareal epicondyle of the femur to the lateral surface of the fibular head, the tendon of the politeus passes deep to the FCL, separating it from the lateral meniscus, the tendon of the biceps femoris is split into two parts by this ligament

Front 297

Describe the ACL.

Back 297

the weaker of the two cruciate ligaments, arises from the anterior intercondylar area of the tibia, just posterior to the attachment of the medial meniscus, it extends superiorly, posteriorly and laterally to attach to the posterior part of the medial side of the lateral condyle of the femur, it limits posterior rolling of the femoral condyles on the tibial platuea during flexion, converting it to spin, it also prevents posterior displacement of the femur on the tibia and hyperextension of the knee joint, when the joint is flexed at a right angle, the tibia cannot be pulled anteriorly because it is held by the ACL

Front 298

Describe the PCL.

Back 298

the stonger of the two cruciate ligaments, arises from the posterior intercondylar area of the tibia, the PCL passes superiorly and anteriorly on the medial side of the ACL to attach to the anterior part of the lateral surface of the medial condyle of the femur, the PCL limits anterior rolling of the femur on the tibial plateau during extension, conerting it to spin, it also prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps prevent hyperflexion of the knee joint, in the weight bearing flexed knee, the PCL is the main stabilizing factor for the femur

Front 299

Describe the posterior meniscofemoral ligament.

Back 299

joints the lateral meniscus to the PCL and the medial femoral condyle

Front 300

Describe the medial meniscus.

Back 300

C-shaped, firmly attached to the tibial collateral ligament, vulnerable to injury, its anterior end (horn) is attached to the anterior intercondylar area of the tibia, anterior to the attachment of the ACL, its posterior end is attached to the posterior intercondylar area, anterior to the attachment of the PCL, the medial meniscus firmly adheres to the deep surface of the TCL, because of its widespread attachments laterally to the tibial intercondylar area and medially to the TCL, the medial meniscus is less mobile on the tibial plateau than is the lateral meniscus

Front 301

Describe the lateral meniscus.

Back 301

O-shaped, not attached to fibular collateral ligament, distinctly mobile, horns of meniscis are attached to bone of tibia

Front 302

What is the extent of the articular cavity?

Back 302

there are numerous bursa associated with the cavity any of which may become inflamed

Front 303

What makes up the posterior aspect of the knee joint?

Back 303

1. adductor magnus tendon
2. superior attachments of lateral and medial heads of gastrocnemius (with underlying bursa)
3. tibial collateral ligament
4. fibular collateral ligament
5. semimembranous tendon
6. biceps femoris tendon
7. popliteus muscle

Front 304

What is the unhappy triad?

Back 304

get 3 structures torn: ACL, tibial collateral ligament, medial meniscus, injury is commonly caused by a blow to the lateral side of the extended knee or excessive lateral twisting of the flexed knee that disrupts the TCL and concomitantly tears and/or detaches the medial meniscus from the joint capsule

Front 305

What is the anterior drawer sign?

Back 305

testes the integrity of the ACL, pull the leg out, the ACL prevents the femur from sliding posteriorly on the tibia and hyperextension of the knee and limits medial rotation of the femur when the foot is on the ground and the leg is flexed

Front 306

Describe the posterior drawer sign?

Back 306

tests the integrity of the PCL, the PCL prevents the femur from sliding anteriorly on the tibia particularly when the knee is flexed

Front 307

What movements are allowed at the knee joint?

Back 307

flexion and extension, some roation occurs when the knee is flexed, when the knee is fully extended with the foot to the ground, the knee passively locks, to unlock the knee the poplitues contracts rotating the femur laterally on the tibial plateau so that flexion of the knee can occur

Front 308

Describe the hip joint.

Back 308

forms the connection between the lower limb and the pelvic girdle, is a strong and stable multiaxial ball and socket type of synovial joint

Front 309

What parts of the femur make up the hip joint?

Back 309

1. head
2. fovea for ligament of head
3. neck
4. greater and lesser trochanter
5. shaft

Front 310

What are the anterior ligament of the hip joint?

Back 310

1. anterior iliofemoral ligament
2. anterior pubofemoral ligament
3. iliopectinal bursa

Front 311

What is the posterior ligament of the hip joint

Back 311

posterior ischiofemoral ligament